Nowadays, our families, especially those living in big cities, are more fortunate in directing their children to any sports branch and can reach us, pediatric cardiologists, for pre-sport evaluation. In the athlete's heart, many physiological changes occur in the heart depending on the type of sport. These are both structural and appear with some findings on heart ultrasound (echocardiography) and are reflected electrically on electrocardiography (ECG).
Depending on the duration and frequency of training, there is an increase in pressure and volume load in the left ventricle of the heart, an increase in the left ventricular wall. There is an increase in thickness (11-13 mm in girls, 13-15 mm in boys), an increase in muscle mass and chamber size, resulting in an increase in the workload of the heart and maximum stroke volume. ECG shows sinus bradycardia due to increased vagal tone, atrial and ventricular ectopy, sinus arrhythmia, wandering supraventricular pacemaker, 1st degree heart block, 2nd degree heart block, T wave changes, increase in QRS voltage, and incomplete right bundle branch block.
The American Heart Association and the American College of Cardiology (ACC) have classified sports types according to the static and dynamic content of sports and published a 14-item guide for cardiovascular screening before participation in sports.
In his personal story; 1. Chest pain, feeling of tightness and discomfort in the chest with exercise 2. Unexplained syncope or fainting 3. Shortness of breath, rapid breathing, weakness or palpitations with exercise 4. Hearing a heart murmur 5. Presence of increased blood pressure 6. Previously prevented from participating in sports 7. Abnormality detected by the physician in cardiac tests
Family history; 8. History of unexplained sudden death before the age of 50 in one or more first-degree relatives in the family. 9. History of heart disease in close relatives under the age of 50. 10. Family members with hypertrophic or dilated cardiomyopathy, long QT syndrome, other ion channelopathies, Marfan syndrome or clinical History of arrhythmia that may be meaningful
In physical examination; 11. Presence of heart murmur 12. Abnormality in femoral pulses (for aortic coarctation) 13. Physical signs of Marfan syndrome 14. Brachia in sitting position arterial blood pressure measurement abnormality
Detailed cardiac evaluation should be performed on each individual according to this 14-item history. First of all, after a careful and detailed physical examination, in addition to ECG and echocardiography, if necessary, stress ECG, genetic arrhythmia tests for some special patient groups, rhythm Holter, blood pressure Holter, respiratory function tests, chest radiography and some biochemical and genetic blood tests should be planned.
In recent years, there has been an increase in the number of reports of sudden cardiac death in athletes. In order to prevent sudden deaths that may occur during exercise, this risk should be minimized by performing all close screenings for heart diseases. It is possible to save lives in case of sudden cardiac arrest by having a defibrillator in sports areas and especially in schools and by providing training on it. Please have the necessary periodic heart checks so that our children have a healthy sports future and can continue sports with peace of mind.
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